Lung cancer and mesothelioma patients have a lot of health-related decisions to make. They need to choose what medical treatments they prefer, where they want to receive care who they want to help them through everyday living.
Ultimately, many of these decisions are partly influenced by a patient’s healthcare plan.
Because most individuals diagnosed with an asbestos-related disease are advanced in years, Medicare is likely to play a major role. At Mesothelioma Circle, we know that this system can be somewhat difficult to navigate through. We want to make sure you know all you can about the different options available to you.
Benefits differ under certain plans
Depending on which Medicare plan you select, your benefits may either come directly from the government or through a private company that contracts with the government.
In the former case, which is known as Original Medicare, there are two options to choose from. Part A covers the cost of care received in a hospital, skilled nursing facility, nursing home or hospice, as well as home health services. Meanwhile, Part B covers both preventive and medically necessary services, such as clinical research, ambulance services, durable medical equipment, mental health, second opinions before surgery and a limited number of outpatient prescriptions.
Often, Original Medicare patients need a separate Medicare drug plan, which comes from a private company that contracts with the government, to cover the cost of medications.
Medicare plans that come from private insurers are known as Medicare Advantage plans. These include HMOs, PPOs, private fee-for-service plans, special needs plans and Medicare medical savings account plans. Prescription coverage comes with these options.
You can learn about other Medicare health plans at the federal website.
Cancer requires extra consideration
Dean Kortge, Ph.D., wrote in Cure magazine that a cancer diagnosis may make selection of the right Medicare plan confusing, prompting him to write a quick review for the publication.
“Medicare coverage of inpatient hospital care is fairly simple – all Medicare patients assume a set percentage of the cost of each hospital admission. Outpatient medical service is more complicated,” Kortge wrote. “Medicare Part B provides coverage for 80 percent of outpatient medical services with the remaining 20 percent left as the patient’s responsibility. That 20 percent responsibility has no ‘out-of-pocket maximum.’ Most chemotherapy treatment is outpatient, which may cause concern, but many people minimize the risk of soaring outpatient costs by purchasing the Medicare alternative plan, Medicare Advantage or Medigap supplement insurance.”
There are 14 types of Medigap supplement insurance, all of which can offer different benefits and may be subject to state laws and individual insurers’ policies. Prescription drugs are usually not covered. It is best to purchase a Medigap plan within the first six months of enrolling in a Medicare plan.
Additionally, Kortge reminds patients that the Part D prescription plan comes with a doughnut-hole in coverage, in which the policy pays for drugs until a limit is reached, and individuals are responsible for payments until their out-of-pocket expenses reach another limit.
Which plan should you pick?
Kortge advises people to do five things before selecting their plans:
- Calculate your annual premiums under the different plans, and add the cost of prescriptions if you are thinking of Medigap.
- Consider the volume of your medical needs – how often you go to the hospital, whether you will need more services over time, etc. Talking to your doctor may help.
- Think about your maximum out-of-pocket expenses for a normal health year, and how illness can affect them.
- Calculate out-of-pocket medication costs.
- Remember you can change your plan annually.
In case you need additional help with medical expenses, visit the National Cancer Institute’s website, which has information various organizations that can help you with various financial, practical and emotional needs.
Also, if you collect damages on an asbestos-related lawsuit, you must remember that you have to repay a large portion of your treatment costs. It helps to have an experienced attorney, who can negotiate with the government, on your side.